Objective To analyze the roles,effects,and key elements of palliative care development in Peking Union Medical College Hospital based on the Consolidated Framework for Implementation Research(CFIR),thus providing a reference for the development of palliative care in other general hospitals. Methods Semi-structured interviews and observation were employed to collect data,which were analyzed and coded in accordance with the CFIR. Results More than 35 000 words were written in the observation diary and 11 subjects were interviewed.A total of 64 codes were extracted,which were categorized into 26 entries in five domains:innovation,external factors,internal factors,individual domains,and implementation process. Conclusion The palliative care model of Peking Union Medical College Hospital has a high degree of generalizability,and it can help general hospitals to explore a palliative care model that is suitable for their own situation.

Background:In traditional Chinese culture, discussing death has always been taboo. The social environment characterized by fear, reluctance, and apprehension toward death significantly impedes the development of palliative care. Therefore, establishing a correct view of life and death and promoting life education are prerequisites for the successful implementation of palliative care. Objective:This study aimed to investigate the public acceptance of life education among individuals in China and analyze the explanatory variables. Methods:This national cross-sectional study was conducted from June 20 to August 31, 2022, encompassing 23 provinces, 5 autonomous regions, and 4 municipalities directly under the central government. A total of 21,875 participants were included. The generalized linear model was used to analyze influencing factors. Gender, major in medicine, place of residence, education level, family health, media use, etc, were analyzed as the potential variables. Acceptance scores were calculated based on a visual analog scale (VAS). Further subgroup analyses were carried out in different age and major subgroups. Results:The median (P25, P75) acceptance score for life education in the survey was 71.00 (50.00-95.00) points. Compared with females, males had lower acceptance (β=-2.39; 95% CI -3.08 to -1.69). Respondents who were majoring in medicine (β=3.13; 95% CI 1.11-5.14), residing in urban areas (β=1.25; 95% CI 0.46-2.04), processing a bachelor's degree or higher (β=4.05; 95% CI 2.97-5.12), or having higher scores on the media use (β=0.49; 95% CI 0.41-0.57) had higher acceptance. Compared with people aged 12-17 years, those aged 25-44 years (β=-6.00; 95% CI -7.34 to -4.66), aged 45-64 years (β=-4.55; 95% CI -5.88 to -3.22), and 65 years or older (β=-2.16; 95% CI -3.78 to -0.55) had lower acceptance. For people majoring in medicine, place of residence, family health, and media use were uniquely relevant factors. Higher scores on the Perceived Social Support Scale (PSSS) and Health Literacy Scale-Short Form (HLS-SF) were also significantly associated with greater acceptance of life education. Conclusions:Gender, place of residence, education level, age, media use, perceived social support, and health literacy were identified as key factors influencing acceptance of life education, providing important evidence to inform targeted policy and educational interventions.

Objective To explore the effect of experiential teaching of hospice care in the life education for medical students and provide possible references for the implementation of life education in medical colleges and universities. Methods Focus group interviews were conducted with medical students who had participated in the experiential teaching of hospice care.Data were collected and subjected to content analysis for the extraction of themes. Results The analysis yielded three themes:(1)Practical scenarios can prompt students to reflect on life education in their personal growth experiences;(2)Real clinical contexts are conducive to the implementation of life education;(3)Experiential teaching in life education helps the growth of medical students. Conclusion Experiential teaching of hospice care can be a feasible method for life education in medical colleges and universities and has certain reference value.

Objective To explore how physicians exercise agency in palliative care under cultural,technological,and institutional constraints. Methods This study integrated death narratives with participatory observation in a palliative care center of a tertiary hospital in Beijing and systematically analyzed the data by reflexive thematic analysis. Results Physicians faced three structural constraints:medical familism at the cultural level,which hindered information sharing and patient autonomy;a technology-first tendency leading to overtreatment and misaligned goals;and institutional resource shortages with marginalized values.In response,they employed three key agency strategies:acting as communication mediators to build trust;serving as decision navigators to refocus families on patient interests;and coordinating care networks to address psychosocial and spiritual needs. Conclusions Physicians demonstrate contextual and strategic agency in palliative care,creating space to improve care under structural constraints.This study provides empirical support for localized practice and highlights the need for institutional reinforcement of physician agency.

By comprehensively utilizing literature analysis to trace the disciplinary evolution and theoretical foundations of palliative medicine globally and domestically,and employing comparative research to examine the discipline accreditation standards and implementation practices from internationally recognized bodies,including the Royal College of Physicians and Surgeons of Canada and the American Board of Medical Specialties,we clearly define the conceptual definitions and logical relationship between palliative care(as clinical practice)and palliative medicine(as an academic discipline).On this basis,we systematically examine the core issues in constructing palliative medicine as a discipline,including its intrinsic development logic(knowledge system architecture)and extrinsic support(institutional frameworks).By analyzing international experiences in discipline development,we propose a context-specific development strategy to promote the systematic and standardized institutionalization of palliative medicine in China.

Through literature review and analysis of clinical practice cases,this paper proposes that narrative dialogue refers to the conscious expression and communication between physicians and patients,with a clear narrative orientation within specific clinical contexts.Its core lies in externalizing patients' implicit,unspoken suffering and establishing empathic connections.Narrative dialogue comprises four constituent elements-context,subject,orientation,and connection-and manifests distinct objectives and characteristics at three levels:value,narrative essence,and practice.This article synthesizes the general core principles and practical steps of narrative dialogue and argues that narrative dialogue constitutes a recognizable,analyzable,and teachable core component in the clinical practice of narrative medicine.It bridges narrative medicine theory with clinical practice and provides a new breakthrough point for the systematic construction of narrative medicine education and clinical paths.

Background: To meet the growing palliative care (PC) needs of China's aging population, we culturally adapted and pilot tested an evidence-based basic PC training program for practicing clinicians. Design: Barrera's framework guided a multistage, surface, and deep structural adaptation of an existing course. We pilot tested the final curricula with 51 participants in September 2022. Participant demographics and postcourse satisfaction survey were descriptively analyzed. Results: A total of 20 nurses and 29 physicians completed the course and instruments. Majority of participants were between 31 and 50 years old (n = 39, 79.6%), female (n = 41, 83.7%), internal medicine trained (n = 30, 61.2%), and worked in tertiary hospitals (n = 47, 95.9). Most participants considered the course quality to be "high" or "very high" (n = 47, 95.9%). Conclusions: Practicing physicians and nurses in mainland China consider this culturally adapted basic PC training to be feasible and acceptable. Future studies should evaluate the effectiveness of PC training and develop strategies to overcome implementation challenges.

BackgroundThe emergency department (ED), usually deemed not the most frequent setting for palliative care (PC), has increasingly been mentioned for its potential critical role in end-of-life patient care. However, how the training affects PC performance remains to be investigated. This study aims to investigate the current PC standard of care and effectiveness of PC training in a Chinese emergency care medical consortium hospital.MethodsWe conducted an anonymous online census targeting the emergency care providers in the consortium hospital. The questionnaire included respondents’ demographics, PC knowledge, PC practice, and whether they have received any PC training. Outcome variables included: confidence in clinical implementation, perceptions about death, and attitudes toward PC implementation with Likert five score rating. Factors associated with better PC knowledge and performance were identified by analysis of the association between rating scores and participant characteristics.Results923 staff participated in the study, while 429 (46.5%) received PC training. Training participation was significantly associated with age, education, occupation, rank, working years, and experience of family members’ death (p < 0.05). Training improved the total score of knowledge and practice of PC (median 90 vs. 100, p < 0.001), the confidence in clinical PC management (confidence score: 36 vs. 40, p < 0.001), and attitudes toward PC implementation (attitude score: 37 vs. 40, p = 0.048). Offline lecture-based learning was the primary training form in this hospital. The ORs of case-based learning, online lecture video, and community training project to higher total scores were 1.94 (95% CI 1.18–3.17, p = 0.009), 2.09 (1.23–3.56, p = 0.006) and 0.17 (0.04–0.63, p = 0.008), respectively. Meanwhile, cased-based learning, online lecture video, and community training project contributed significantly to the confidence score. So did the lecture offline to the score of perception about death (perception score). The OR of meeting online to attitude score was 1.69 (1.05–2.73, p = 0.030).ConclusionPalliative care training is associated with better self-rating of PC among ED care providers. However, there is a significant gap for improvement, particularly for the community training programs.

BACKGROUND AND OBJECTIVE: Patients with glioma experience a high symptom burden and have diverse palliative care needs. However, the assessment scales used in palliative care remain non-standardized and highly heterogeneous. To evaluate the application patterns of the current scales used in palliative care for glioma, we aim to identify gaps and assess the need for disease-specific scales in glioma palliative care. METHODS: We conducted a systematic search of five databases including PubMed, Web of Science, Medline, EMBASE, and CINAHL for quantitative studies that reported scale-based assessments in glioma palliative care. We extracted data on scale characteristics, domains, frequency, and psychometric properties. Quality assessments were performed using the Cochrane ROB 2.0 and ROBINS-I tools. RESULTS: Of the 3,405 records initially identified, 72 studies were included. These studies contained 75 distinct scales that were used 193 times. Mood (21.7%), quality of life (24.4%), and supportive care needs (5.2%) assessments were the most frequently assessed items, exceeding half of all scale applications. Among the various assessment dimensions, the Distress Thermometer (DT) was the most frequently used tool for assessing mood, while the Short Form-36 Health Survey Questionnaire (SF-36) was the most frequently used tool for assessing quality of life. The Mini Mental Status Examination (MMSE) was the most common tool for cognitive assessment. Performance status (5.2%) and social support (6.8%) were underrepresented. Only three brain tumor-specific scales were identified. Caregiver-focused scales were limited and predominantly burden-oriented. CONCLUSIONS: There are significant heterogeneity, domain imbalances, and validation gaps in the current use of assessment scales for patients with glioma receiving palliative care. The scale selected for use should be comprehensive and user-friendly.

BackgroundTelehealth technologies can enhance patients’ and their families’ access to high-quality resources in home-based palliative care. Nurses are deeply involved in delivering telehealth in home-based palliative care. However, no previous integrative systematic reviews have synthesized evidence on nurses’ roles, facilitators, and barriers to implementing nurse-delivered telehealth in home-based palliative care. ObjectiveThis integrative systematic review aimed to provide a comprehensive understanding of the roles of nurses and the multilevel facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care, which could inform future policy development, research, and clinical practice. MethodsThis integrative systematic review was conducted using Joanna Briggs Institute methodological guidance. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We systematically searched articles published from January 1, 2014, to May 2024 in PubMed, Embase, Web of Science, CINAHL, and Cochrane Library. We included English-language; peer-reviewed; original; and qualitative, quantitative, and mixed methods studies that centered on nurse-delivered telehealth in home-based palliative care. We used the Mixed Methods Appraisal Tool to assess the quality of the included articles. Furthermore, 3 authors independently assessed eligibility, extracted data, and assessed the quality of articles. The entities to extract were identified by research questions of interest regardless of the type of study. We applied a convergent synthesis approach to integrate quantitative and qualitative data. Guided by the updated Consolidated Framework for Implementation Research (CFIR) 2.0, we synthesized the facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care. ResultsThis integrative systematic review identified 4819 unique articles, including 34 papers encompassing 29 unique primary research studies. Innovations were mainly delivered by nurses (n=8) and nurse-involved multiprofessional teams (n=18). The roles of nurses in telehealth home-based palliative care involve palliative care nurses, community nurses, nurse coordinators, nurse coaches or nurse navigators, and nurse case managers. Guided by CFIR 2.0, facilitators and barriers to implementing nurse-delivered, telehealth, home-based palliative care were identified to 6 implementation levels and 20 constructs. The key facilitators included the COVID-19 pandemic, cost avoidance to the health care system, engagement of patients and their family caregivers, and so on. The barriers included a lack of reimbursement and payment mechanisms, technical problems, insufficiently trained health care providers, and so on. ConclusionsThis integrative systematic review synthesizes evidence on nurses’ evolving roles in telehealth home-based palliative care and identifies multilevel facilitators and barriers to nurse-delivered, home-based palliative care implementation. With the empowerment of telehealth technologies, nurses could establish a stronger professional identity and develop leadership in home-based palliative care. Nurses should leverage influence to promote nursing practice, clinical management, and policy support in the implementation of telehealth home-based palliative care. Trial RegistrationPROSPERO CRD42024541038; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024541038

China’s aging population will escalate palliative care (PC) needs in the next decade. Scalable and culturally-adapted training is necessary to equip practicing clinicians with essential PC skills. The objective of this study is to evaluate a culturally-adapted basic PC training course in mainland China. A total of 29 practicing physicians from Zhejiang Province, China, were selected to participate in an in-person training program that spanned six days. We analyzed pre- and post-course quantitative surveys on knowledge, self-efficacy, and behavior using descriptive statistics. We also thematically analyzed post-course semi-structured participant interviews. The majority of participants were aged 41–50 (51.7

As palliative care practice gradually undertakes important missions in both the medical field and the society,it has become an emerging disciplinary area that meets the needs of the times.At the same time,the discipline construction of palliative medicine has become a crucial issue that urgently needs to be addressed in the cause of palliative care in China.In this article,we trace the origin of the concept of palliative care and classify,sort out,and expound the research objects,research contents,research methods,etc.of palliative medicine by combining the methods of literature analysis and focus group interviews.According to the development context and evolution process of palliative care,we put forward the proposition of building a discipline of palliative medicine,with the aim of helping the academic community distinguish the connotation and denotation of the disciplinary definition and laying a foundation for the work of discipline construction.

The CACA clinical guidelines for psychosocial care provide a framework and systematic recommendations for addressing psychological issues in patients with cancer, as well as for meeting the psychosocial needs of cancer patients and their families. These recommendations facilitate the integration of psychosocial care into routine clinical cancer care, enhancing holistic treatment approaches. Regular distress screening for cancer patients is recommended and should be conducted using a strategic process with an electronic platform. Specific assessment tools, medications, and non-pharmaceutical interventions are provided for common symptoms such as anxiety, depression, insomnia, pain, fatigue, and delirium. Additionally, various evidence-based psychotherapies are recommended for patients experiencing specific psychological distress and addressing different individual needs.

Objective: To investigate the perceptions of pancreatic surgeons regarding palliative care for pancreatic cancer and the current status of palliative care for pancreatic cancer patients in China. Methods: An online questionnaire consisting of 35 questions in 5 domains, including basic information of the respondents, personal interest, training and experiences of palliative care, recognition of the importance of palliative care, palliative care in the hospital of the respondents, and advice to improve the service of palliative care for pancreatic cancer, was distributed to pancreatic surgeons by the WeChat APP. All the data were automatically recorded and can be downloaded. The respondents’ perceptions of palliative care and the current status of palliative care were depicted, and the factors influencing the perceptions of the respondents and palliative care in hospitals were further analyzed. Results: Responses from 429 pancreatic surgeons were validated. 81.4% were from tertiary hospitals, and 18.6% were from secondary hospitals. 94.2% were from general hospitals, and 5.8% were from cancer hospitals. Most surgeons have worked for over 5 years (93%), 72% had senior titles, and 54.5% held administrative positions. 49% have not read papers on palliative care before. 73.4% of the hospitals did not have a palliative care team, 77.9% did not have specific ward or bed for palliative care, 76.2% of the surgeons thought palliative care needed more attention in their hospitals. 97.4% of the surgeons thought palliative care was important for pancreatic cancer patients, and 94.9% were willing to join the palliative team. 46.6% of the surgeons thought palliative care should be conducted once pancreatic cancer was diagnosed. Most surgeons thought palliative care was helpful and should be involved in the multidisciplinary team. Regarding the geographical differences, surgeons and hospitals in North China performed better than in other regions. Surgeons with experience in clinical trials of pancreatic cancer performed better. The top 3 advice from the surgeons to promote palliative care were more education and training, seminars, and public broadcasting. 69.9% of the surgeons have concerns about the legal issue of implementation of palliative care. Conclusion: In general, the majority of pancreatic surgeons in China lack training and experience in palliative care for pancreatic cancer, and the current status of palliative care in most hospitals needs to be further improved. Prevalence of the participants think that palliative care is very important for pancreatic cancer patients. Palliative care should be provided once pancreatic cancer is diagnosed, and palliative care should be involved in the multidisciplinary team. More seminars, education and training, and public broadcasting are practical ways to improve palliative care for pancreatic cancer patients.

Objective To describe the palliative care model in the Peking Union Medical College Hospital and provide a reference for the palliative care work in other general hospitals. Methods A field study was carried out at the Palliative Medicine Center of Peking Union Medical College Hospital.Data were collected by participatory observation,in-depth interviews,and physical collection,and the thematic analysis was performed to refine the themes and analyze the results. Results A total of 9 themes were obtained and the "Banyan Tree Model" was summarized. Conclusion The palliative care model in the Peking Union Medical College Hospital is suitable for the development of palliative care in general hospitals and has a reference value.

With the rapid development of medical technology, human dying process has been technicalized and medicalized, but the pain caused by ageing and terminal disease remains widespread. However, Palliative care can alleviate this kind of pain and improve the quality of life for end-stage patients.Over the years, China has introduced a series of policies and laws to include hospice care in the national health system from the legislative level, most healthcare providers, however, are incompetent and unable to understand and deliver palliative care, resulting in the poor quality of death in China. Integration of palliative care into the health system needs to be gradually implemented, by unifying definitions and principles, advocating palliative care practice in clinical work, initiating education in medical students, developing palliative care networks in primary healthcare system, formulating national-level development indicators, and emphasizing localized development, with the hope of avoiding futile or inappropriate treatments at the end of life.

Dyspnea, the subjective sensation of breathlessness, is a common source of distress for patients living with advanced cancer. Effective assessment and management of dyspnea among patients living with advanced cancer represents core competencies for front-line clinicians and professional caregivers. However, there is still a lack of standardized procedures for handling dyspnea in China. Based on evidence-based medicine, the American Society of Clinical Oncology practice guidelines for management of dyspnea in advanced cancer was released, which outlines assessment and management of dyspnea among patients living with advanced cancer. This article aims to provide detailed interpretation of key clinical content to guide China's clinical practice.

Objective The International Medical Services Department of Peking Union Medical College Hospital (PUMCH) has gradually promoted the concept and practice of palliative care since 2016. This study aims to analyze the death status of end-of-life patients before and after the promotion endeavor, in order to evaluate the impact of palliative care on the death quality. Methods All clinical data from end-of-life patients who died at the International Medical Services Department of PUMCH in 2013 and 2019 were retrospectively collected, and their diagnosis and treatment details before death were compared. Results A total of 36 end-of-life patients who died in 2013 and 37 end-of-life patients who died in 2019 met the inclusion and exclusion criteria. In 2013, there were 19 males and 17 females, with an average age of (72.1±14.0) years, and 19 cases had advanced cancer. In 2019, there were 19 males and 18 females, with an average age of (70.8±15.3) years, and 27 cases had advanced cancer. Compared to patients who died in 2013, a lower proportion of the patients in 2019 who were transferred to the ICU before death(0 vs. 22.2%, P=0.008), received cardiopulmonary resuscitation (0 vs. 16.7%, P=0.011), had tracheal intubation(5.4% vs. 36.1%, P=0.001), invasive mechanical ventilation(2.7% vs. 33.3%, P=0.001), and total parenteral nutrition(32.4% vs. 61.1%, P=0.014), while a higher proportion received palliative care consultations(29.7% vs. 0, P<0.001), and humanistic care(40.5% vs. 16.7%, P=0.024). In 2019, compared to the patients who did not receive palliative care consultations, those who received palliative care consultations had a higher proportion of humanistic care(90.9% vs. 19.2%, P<0.001). Conclusions After concept promotion and practice of palliative care, the proportion of end-of-life patients receiving invasive treatments before death in the International Medical Services Department of PUMCH has significantly decreased, the proportion receiving humanistic care has significantly increased, and the quality of death has been improved to a certain extent.

Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor with a poor prognosis and limited survival. Patients with GBM have a high demand for palliative care. In our present case, a 21-year-old female GBM patient received inpatient palliative care services including symptom management, mental and psychological support for the patient, psychosocial and clinical decision support for her family members, and pre- and post-death bereavement management for the family. Furthermore, we provided the family members with comprehensive psychological preparation for the patient's demise and assisted the patient's family throughout the mourning period.The aim of this study is to provide a reference and insights for the clinical implementation of palliative care for patients with malignant brain tumors.

Pain is one of the most common symptoms in cancer patients. Apart from causing patients to suffer from unpleasant feelings and negative emotional experiences, uncontrolled pain may also influence patients' function and quality of life, and may be associated with poorer prognosis. Poor management of chronic cancer-related pain may be related to its complicated mechanisms, limitations of current clinical treatment and clinicians' and patients' insufficient understanding of the symptom. Therefore, this review summarizes the definitions, classifications, evaluation and treatment principles of chronic cancer-related pain, and emphasises the importance of multidisciplinary management and patient education in cancer pain management to provide clinicians with the overall idea of pain management in adult cancer patients.